Valve Replacement an Option for More Patients Thanks to New Minimally Invasive TAVR Procedure

April 29, 2013 -- In late March, Selma Milton became a trendsetter. The 86-year-old resident of Leonia became the first patient at The Valley Hospital Heart and Vascular Institute to receive a new aortic heart valve put into place using a new procedure called transcatheter aortic valve replacement (TAVR).

TAVR is a minimally invasive procedure that is used to treat patients with the only FDA-approved transcatheter heart valve, the Edwards SAPIEN. The culmination of more than 50 years of continuous refinement in heart valve technology and treatment, TAVR provides an important new treatment option for patients with severe, symptomatic aortic valve stenosis, for whom traditional valve replacement surgery is not an option.

Janet Strain, M.D., director of Valley’s Cardiac Catheterization Laboratory, who performed Mrs. Milton’s TAVR in collaboration with Valley’s Director of Cardiac Surgery, Alex Zapolanski, M.D., says patients with aortic stenosis often develop debilitating symptoms that may include difficulty walking or performing normal day-to-day activities. The disease occurs when calcification builds up in the valve, causing it to narrow. As a result, blood cannot flow through the valve efficiently, and the heart must work harder to compensate.

“Aortic stenosis may eventually become life-threatening,” explains Dr. Strain. “Without valve replacement, many of these patients do not survive more than an average of two years after the onset of symptoms.”

For patients who are considered high-risk or inoperable due to poor overall health, there have been few available alternatives to improve longevity and quality of life. TAVR has changed that.

TAVR is minimally invasive, requiring only a small incision in the groin, through which the Edwards SAPIEN aortic valve (loaded on a deflated balloon) is threaded from the groin artery up to the heart. The balloon is then inflated to position the new aortic valve into place in the heart, where it displaces the patient’s diseased aortic valve. The patient’s heart continues to beat during the procedure, thus eliminating the need for a heart-lung bypass machine.

“In clinical trials of more than 1,000 patients, those treated with the Edwards SAPIEN valve had improved survival and improved quality of life at one year, as compared to patients not treated with the valve,” notes Dr. Strain. The Valley Hospital Heart and Vascular Institute’s highest recognition (three stars) by the Society for Thoracic Surgeons for aortic valve replacement – given to only 5.9 percent of cardiac programs nationwide – illustrates the quality and clinical excellence of Valley’s cardiac services.

“Our expertise and the number of complex cases we treat successfully enable us to understand and decide, better than cardiac teams at many other facilities, which high-risk patients would benefit from a minimally invasive approach, such as TAVR, and which patients should undergo classical aortic valve replacement surgery,” notes Dr. Zapolanski.

Before undergoing TAVR at Valley, Mrs. Milton was so weak that just making her bed left her breathless and exhausted. She was too ill to take a trip to Massachusetts to meet her newest great-grandson, who was born in November.

“Dr. Strain has been my husband’s cardiologist for many years and Valley is our family hospital, so even though I was nervous about being the first to have this procedure at Valley, I knew I was in good hands and trusted my doctors and nurses,” says Mrs. Milton.

After a three-day hospitalization, Mrs. Milton is now regaining strength with the assistance of her “very special man,” her husband of 67 years, Charlie Milton. She has been able to cook some meals and will meet her newest great-grandchild, her sixth, later this month when he arrives for a visit. Feeling better after her procedure, she and Charlie intend to return to visiting residents at the Van Dyke Nursing Home in Ridgewood, an activity they have enjoyed for the past 28 years.

The Valley Hospital recently received its 10th consecutive J.D. Power and Associates Distinguished Hospital Program award for providing an “outstanding inpatient experience” and has been recognized by HealthGrades as #1 in New Jersey for cardiac services, cardiac surgery, and coronary interventional procedures. Additionally, as a recipient of the prestigious Beacon Award for Excellence in critical care nursing, The Valley Hospital is uniquely qualified to provide the highest level of care and the most innovative treatment for severe, symptomatic aortic stenosis through a multidisciplinary approach by members of the Heart & Vascular Institute.

For more information about TAVR, please call Denise Goldstein, APN, or Mary C. Collins, APN, program co-coordinators, at 201-447-TAVR (8287).